Q. I work in a community mental health clinic in Washington state. I work with the most impaired clients--trying to avoid hospitalizations. We are currently conducting DBT groups (Dialectical Behavioral Therapy--Dr. Marsha Linehan) to assist clients with BPD.

I have 2 questions:
1) What is your basic premise on how to help clients with this d/o.
2) Do you think it's possible that bpd is often diagnosed as bipolar, rapid cycling? What about a client who has dramatic mood changes throughout the day--i.e. crying at 9am, laughing and joking at 930am, crying/despondent at 1030am etc.?

  A. I do not know if medications can help you or not. My belief is that you give a patient as many chances as possible to get well. Meds plus therapy is two chances. Meds alone or therapy alone is one chance. I feel everyone should give medications a try.

There are scores of letters on this site discussing medications and how to dose them. You must take enough if you are going to use any medications for BPD. Too little is no good at all.